Allergic rhinitis, pollenosis or hay fever is an allergic inflammation of the nasal airways. It occurs when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, and triggers antibody Antibodies are gamma globulin proteins that are found in blood or other bodily fluids of vertebrates, and are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses. They are typically made of basic structural units—each with two large heavy chains and two small light chains—to form, for example, production. These antibodies mostly bind to mast cells A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin. Although best known for their role in allergy and anaphylaxis, mast cells play an important protective role as well, being intimately involved in wound healing and defense against pathogens, which contain histamine Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by basophils and by mast cells found in nearby connective. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. It is a viscous colloid containing antiseptic enzymes (such as lysozyme), proteins such as lactoferrin, glycoproteins known as mucins that are produced by goblet cells in the mucous membranes and submucosal glands, immunoglobulins, and inorganic salts. This production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives Urticaria (from the Latin urtica, nettle urere, to burn) (or hives) are a kind of skin rash notable for dark red, raised, itchy bumps. Hives are frequently caused by allergic reactions; however, there are many non-allergic causes. For example, most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger or other rashes A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful. The causes, and therefore treatments for rashes, vary widely. Diagnosis. Particulate matter in polluted air and chemicals such as chlorine Chlorine (pronounced /ˈklɔəriːn/ KLOR-een, from the Greek word 'χλωρóς' , is the chemical element with atomic number 17 and symbol Cl. It is a halogen, found in the periodic table in group 17 (formerly VII, VIIa, or VIIb). As the chloride ion, which is part of common salt and other compounds, it is abundant in nature and necessary to and detergents, which can normally be tolerated, can greatly aggravate the condition.

Classification

The two categories of allergic rhinitis Rhinitis , commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or irritants. The inflammation results in the include:

• Seasonal – occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.
• Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.^[1]

Signs and symptoms

Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.^[2]

Sufferers might also find that cross-reactivity occurs.^[3] For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes.^[4] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food.^[5] There are many cross-reacting substances.

Some disorders may be associated with allergies: Comorbidities In medicine, comorbidity is either the presence of one or more disorders (or diseases) in addition to a primary disease or disorder, or the effect of such additional disorders or diseases include eczema Eczema is a form of dermatitis, or inflammation of the epidermis, asthma Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath, depression Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder and migraine Migraine is a neurological syndrome characterized by altered bodily perceptions, severe headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne . The French term derived from a vulgar pronunciation of the Late Latin word.^[6]

Cause

Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies. It is roughly estimated that one in three people have an active allergy at any given time and at least three in four people develop an allergic reaction at least once in their lives.

Allergic rhinitis triggered by the pollens Pollen is a fine to coarse powder containing the microgametophytes of seed plants, which produce the male gametes . Pollen grains have a hard coat that protects the sperm cells during the process of their movement between the stamens to the pistil of flowering plants or from the male cone to the female cone of coniferous plants. When pollen lands of specific seasonal plants is commonly known as "hay fever", because it is most prevalent during haying Hay is grass, legumes or other herbaceous plants that have been cut, dried, and stored for use as animal fodder, particularly for grazing livestock such as cattle, horses, goats, and sheep. Hay is also fed to pets such as rabbits and guinea pigs. Pigs may be fed hay, but they do not digest it as efficiently as more fully herbivorous animals season. However, it is possible to suffer from hay fever throughout the year. The pollen which causes hay fever varies between individuals and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated Anemophily or wind pollination is a form of pollination whereby pollen is distributed by wind. Anemophilous plants may be either gymnosperms or angiosperms (flower-producing). However, flowering anemophilous species do not develop scented flowers, nor do they produce nectar. This distinguishes them from entomophilous and zoophilous species (whose plants Plants are living organisms belonging to the kingdom Plantae. They include familiar organisms such as trees, herbs, bushes, grasses, vines, ferns, mosses, and green algae. The scientific study of plants, known as botany, has identified about 350,000 extant species of plants, defined as seed plants, bryophytes, ferns and fern allies. As of 2004, are the predominant cause. Pollens of insect-pollinated Entomophily is a form of pollination whereby pollen is distributed by insects, particularly bees, Lepidoptera , flies and beetles. Entomophilous species frequently evolve mechanisms to make themselves more appealing to insects, e.g., brightly-colored or scented flowers, nectar, or appealing shapes and patterns. Pollen grains of entomophilous plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:

• Trees: such as pine , birch (Betula Birch is the name of any tree of the genus Betula , in the family Betulaceae, closely related to the beech/oak family, Fagaceae), alder (Alnus Alder is the common name of a genus of flowering plants belonging to the birch family (Family Betulaceae). The genus comprises about 30 species of monoecious trees and shrubs, few reaching large size, distributed throughout the North Temperate Zone and in the Americas also along the Andes southwards to Argentina), cedar, hazel, hornbeam (Carpinus), horse chestnut (Aesculus The genus Aesculus comprises 13-19 species of woody trees and shrubs native to the temperate northern hemisphere, with 6 species native to North America and 7-13 species native to Eurasia; there are also several hybrids. Species are deciduous or evergreen. This genus has traditionally been treated in the ditypic family Hippocastanaceae along with), willow (Salix Willows, sallows, and osiers form the genus Salix, around 400 species of deciduous trees and shrubs, found primarily on moist soils in cold and temperate regions of the Northern Hemisphere. Most species are known as willow, but some narrow-leaved shrub species are called osier, and some broader-leaved species are referred to as sallow . Some), poplar Populus is a genus of 25–35 species of deciduous flowering plants in the family Salicaceae, native to most of the Northern Hemisphere. English names variously applied to different species include poplar, aspen, and cottonwood, plane (Platanus Platanus is a small genus of trees native to the Northern Hemisphere. They are the sole living members of the family Platanaceae), linden/lime (Tilia Tilia is a genus of about 30 species of trees, native throughout most of the temperate Northern Hemisphere, in Asia , Europe and eastern North America; it is not native to western North America. Under the Cronquist classification system, this genus was placed in the family Tiliaceae, but genetic research by the APG has resulted in the) and olive (Olea Olea is a genus of about 20 species in the family Oleaceae, native to warm temperate and tropical regions of southern Europe, Africa, southern Asia and Australasia. They are evergreen trees and shrubs, with small, opposite, entire leaves. The fruit is a drupe). In northern latitudes birch is considered to be the most important allergenic tree pollen, with an estimated 15–20% of hay fever sufferers sensitive to birch pollen grains. Olive pollen is most predominant in Mediterranean regions.
• Grasses (Family Poaceae Poaceae is a family in the Class Liliopsida (the monocots) of the flowering plants. Plants of this family are usually called grasses, or, to distinguish them from other graminoids, true grasses; the shrub- or tree-like plants in this family are called bamboo (there are also herbaceous, non-woody bamboos). There are about 600 genera and some 9,000�): especially ryegrass Ryegrass is a genus of nine species of tufted grasses, family Poaceae. Also called tares (even though there is no firm evidence that this is the same as the plant given that name in English language translations of the Bible - vetches are another candidate), these plants are native to Europe, Asia and northern Africa, but are widely cultivated and (Lolium sp.) and timothy Timothy-grass , is an abundant perennial grass native to most of Europe except for the Mediterranean region. It grows to 50–150 cm tall, with leaves up to 45 cm long and 1 cm broad. The flowerhead is 7–15 cm long and 8–10 mm broad, with densely packed spikelets (Phleum pratense). An estimated 90% of hay fever sufferers are allergic to grass pollen.
• Weeds: ragweed Ragweeds , also called bitterweeds or bloodweeds, are a genus of flowering plants from the sunflower family (Asteraceae) (Ambrosia), plantain (Plantago Plantago is a genus of about 200 species of small, inconspicuous plants commonly called plantains. They share this name with the very dissimilar plantain, a kind of banana. Most are herbaceous plants, though a few are subshrubs growing to 60 cm tall. The leaves are sessile, but have a narrow part near the stem which is a pseudo-petiole. They have), nettle Nettle is the common name for between 30-45 species of flowering plants of the genus Urtica in the family Urticaceae, with a cosmopolitan though mainly temperate distribution. They are mostly herbaceous perennial plants, but some are annual and a few are shrubby/parietaria (Urticaceae Urticaceae, or the nettle family, is a family of flowering plants. The family name comes from the genus Urtica . Urticaceae includes a number of well-known, interesting and useful plants, including the aforementioned nettles, ramie (Boehmeria nivea), māmaki (Pipturus albidus), and ajlai (Debregeasia saeneb)), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel Common Sorrel or Garden Sorrel , often simply called sorrel and also known as Spinach Dock or Narrow-leaved Dock, is a perennial herb that is cultivated as a garden herb or leaf vegetable (pot herb). This is not related to Jamaican sorrel (roselle)/dock (Rumex The docks and sorrels, genus Rumex L., are a genus of about 200 species of annual, biennial and perennial herbs in the buckwheat family Polygonaceae)

Diagnosis

Allergy testing may reveal the specific allergens an individual is sensitive to. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. (This test should only be done by a physician, never the patient, since it can be harmful if done improperly). In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test A RAST test is a blood test used to determine to what substances a person is allergic. This is different from a skin allergy test, which determines allergy by the reaction of a person's skin to different substances may be helpful in determining specific allergen sensitivity.

Management

The goal of rhinitis treatment is to reduce the symptoms caused by the inflammation of affected tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to completely avoid the allergen.^[7][8] Vasomotor rhinitis can be brought under a measure of control through avoidance of irritants, though many irritants, such as weather changes, are uncontrollable.

Allergic rhinitis can typically be treated much like any other allergic condition. Eliminating exposure to allergens is the most effective preventive measure, but requires consistent effort. Many people with pollen allergies reduce their exposure by remaining indoors during hay fever season, particularly in the morning and evening, when outdoor pollen levels are at their highest. Closing all the windows and doors prevents wind-borne pollen from entering the home or office. When traveling in a vehicle, closing all the windows reduces exposure. Air conditioners An air conditioner is a home appliance, system, or mechanism designed to dehumidify and extract heat from an area. The cooling is done using a simple refrigeration cycle. In construction, a complete system of heating, ventilation, and air conditioning is referred to as "HVAC". Its purpose, in a building or an automobile, is to provide are reasonably effective filters, and special pollen filters can be fitted to both home and vehicle air conditioning systems.^[9]

Rinsing is very often recommended as part of the healing process after sinus or nasal surgery. For this rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of the bottle is used..^[10]

Antihistamines

Several antagonistic A receptor antagonist is a type of receptor ligand or drug that does not provoke a biological response itself upon binding to a receptor, but blocks or dampens agonist-mediated responses. In pharmacology, antagonists have affinity but no efficacy for their cognate receptors, and binding will disrupt the interaction and inhibit the function of an drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines A histamine antagonist is an agent that inhibits action of histamine via histamine receptors. H1 antihistamines are used as treatment for symptoms of allergies such as runny nose. Allergies are caused by an excessive type 1 hypersensitivity response of the body to allergens, such as pollen released by plants. An allergic reaction, which if severe, cortisone Cortisone (pronounced /ˈkɔrtɨsoʊn/ or /ˈkɔrtɨzoʊn/ ) (17-hydroxy-11-dehydrocorticosterone) is a steroid hormone. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally, intraarticularly, or cutaneously. Cortisone suppresses the, dexamethasone Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant. Its potency is about 20-30 times that of the naturally occurring hormone hydrocortisone and 4-5 times of prednisone, hydrocortisone Cortisol, also known as hydrocortisone, is a steroid hormone or glucocorticoid produced by the adrenal gland. It is released in response to stress, or to a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis, suppress the immune system, and aid in fat, protein and carbohydrate metabolism, epinephrine Epinephrine is a hormone and neurotransmitter.. It increases heart rate, contracts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. Chemically, epinephrine is a catecholamine, a monoamine produced only by the adrenal glands from the amino acids phenylalanine and tyrosine (adrenaline), theophylline Theophylline, also known as dimethylxanthine, is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. Due to its numerous side-effects, these drugs are now rarely administered for clinical use. As a member of the xanthine family, it bears structural and pharmacological similarity to and cromolyn sodium Cromoglicic acid (also referred to as cromolyn (USAN), cromoglycate (former BAN), or cromoglicate) is traditionally described as a mast cell stabilizer, and is commonly marketed as the sodium salt sodium cromoglicate or cromolyn sodium. This drug prevents the release of inflammatory chemicals such as histamine from mast cells. Anti-leukotrienes Leukotrienes are fatty molecules of the immune system that contribute to inflammation in asthma and allergic rhinitis. Leukotriene antagonists are used to treat these diseases, such as montelukast Montelukast is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies. It is usually administered orally. Montelukast is a CysLT1 antagonist; that is it blocks the action of leukotriene D4 (and secondary ligands LTC4 and LTE4) on the cysteinyl leukotriene receptor CysLT1, are FDA approved for treatment of allergic diseases.^[11] One antihistamine, azelastine Azelastine is a potent, second-generation, selective, histamine antagonist manufactured by MedaPharma. According to the Allergic Rhinitis and its Impact on Asthma (ARIA) treatment guidelines, intranasal anti-histamines are recommended for the first line therapy of mild intermittent, moderate/severe intermittent and mild persistent rhinitis (new, is available as a nasal spray.

Many allergy medications can have undesirable side-effects, most notably drowsiness Somnolence is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods (cf. hypersomnia). It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm. The disorder characterized by the latter.

A case-control Case-control is a type of epidemiological study design. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects who have that condition with patients who do not have the condition but are otherwise similar (the 'controls') study found "symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations".^[12]

Another study “suggests that drivers who need antihistamine drugs should avoid those that act centrally” because they “greatly impaired driving behaviour” ^[13]

Steroids

Systemic steroids such as prednisone are effective at reducing nasal inflammation, but their use is limited by their short duration of effect and the side effects of prolonged steroid therapy. Steroid nasal sprays are effective and safe, and may be effective without oral antihistamines. They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Decongestants

Pseudoephedrine is also indicated for vasomotor rhinitis,

Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).

Desensitization

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses.

Alternative treatments

Therapeutic efficacy of complementary-alternative treatments is not supported by currently available evidence.^[14][15] It has been claimed that homeopathy provides relief free of side-effects. However, this is strongly disputed by the medical profession on the grounds that there is no valid evidence to support this claim.^[16]

The World Health Organization places allergic rhinitis (including hayfever) on its list of diseases, symptoms or conditions that acupuncture has been proved, through controlled trials, to be an effective treatment for.^[17]

While some people believe eating unfiltered honey helps with rhinitis, this is not backed up by a recent study.^[18]

Epidemiology

In Western countries between 10—25% of people annually are affected by allergic rhinitis.^[19]

References

1. ^ "Rush University Medical Center". http://www.rush.edu/rumc/page-1098987384061.html. Retrieved 2008-03-05.
2. ^ Valet RS, Fahrenholz JM. Allergic rhinitis: update on diagnosis. Consultant. 2009;49:610-613
3. ^ Czaja-Bulsa G, Bachórska J (1998). "[Food allergy in children with pollinosis in the Western sea coast region]". Pol Merkur Lekarski 5 (30): 338–40. PMID 10101519.
4. ^ Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S, Kataura A (2005). "[Relationship between pollen allergy and oral allergy syndrome]". Nippon Jibiinkoka Gakkai Kaiho 108 (10): 971–9. PMID 16285612.
5. ^ Malandain H (2003). "[Allergies associated with both food and pollen]". Allerg Immunol (Paris) 35 (7): 253–6. PMID 14626714.
6. ^ "Allergists Explore Rising Prevalence and Unmet Needs Attributed to Allergic Rhinitis". ACAAI. November 12, 2006. http://www.acaai.org/public/linkpages/NR+Rising+Prevalence+and+Unmet+Needs+of+Allergic+Rhinitis.htm. Retrieved 2008-10-01.
7. ^ "The Facts about Hay Fever". Healthlink. University of Wisconsin. http://healthlink.mcw.edu/article/1031002426.html. Retrieved 2007-06-19.
8. ^ "NHS advice on hayfever". http://www.nhs.uk/Conditions/Hay-fever/Pages/Prevention.aspx?url=Pages/Lifestyle.aspx.
9. ^ Steven Jay Weiss. "Seasonal Allergic Rhinitis". http://www.suggestadoctor.com/health_article_28.htm. Retrieved 2009-01-28.
10. ^ Australian Society of Clinical Immunology and Allergy
11. ^ eMedicine Health Hay Fever Causes, Symptoms, and Treatment on eMedicineHealth.com
12. ^ Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A (2007). "Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study". J. Allergy Clin. Immunol. 120 (2): 381–7. doi:10.1016/j.jaci.2007.03.034. PMID 17560637.
13. ^ T Betts, D Markman, S Debenham, D Mortiboy, and T McKevitt.. "Effects of two antihistamine drugs on actual driving performance.". http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444070/. Retrieved 1984 January 28.
14. ^ Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J (2006). "ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma". J. Allergy Clin. Immunol. 117 (5): 1054–62. doi:10.1016/j.jaci.2005.12.1308. PMID 16675332.
15. ^ Terr A (2004). "Unproven and controversial forms of immunotherapy". Clin Allergy Immunol. 18 (1): 703–10. PMID 15042943.
16. ^ Susan O'Meara, Paul Wilson, Chris Bridle, Jos Kleijnen and Kath Wright (2002). "Effective Health Care: Homeopathy" (PDF). NHS Centre for Reviews and Dissemination. http://www.york.ac.uk/inst/crd/EHC/ehc73.pdf. Retrieved 2007-06-10. "There are currently insufficient data ... to recommend homeopathy as a treatment for any specific condition. Also, many people believe eating local honey year-round acclimates the body to pollen, thereby significantly reducing the allergic effect."
17. ^ World Health Organisation (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Geneva: WHO. 87. ISBN 9789241545433.
18. ^ Rajan TV, Tennen H, Lindquist RL, Cohen L, Clive J (February 2002). "Effect of ingestion of honey on symptoms of rhinoconjunctivitis". Ann. Allergy Asthma Immunol. 88 (2): 198–203. PMID 11868925.
19. ^ Dykewicz MS, Hamilos DL (February 2010). "Rhinitis and sinusitis". J. Allergy Clin. Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.

Categories: Rhinology | Allergology

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